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SalaryOverview:
The Revenue Cycle Claim Specialist ensures accurate billing and collection of medical services by performing essential financial processes, adhering to regulations and compliance guidelines, while maintaining the highest standards of patient confidentiality and data security. This includes editing and resolving claims according to regulations and compliance guidelines, patient account research and resolution, insurance verification and benefit determinations, identification of reimbursement issues, resolution of credits and issuance of refunds, identification of payment variance on invoices, and follow-up and resolution of denied claims. This role is responsible for the timely and accurate working of correspondence, denials, and insurance follow-up.Responsibilities:
**This role is a fully remote position**
Unified Women’s Healthcare is a company dedicated to caring for Ob-Gyn providers who care for others, be they physicians or their support staff. A team of like-minded professionals with significant business and healthcare experience, we operate with a singular mindset - great care needs great care. We take great pride in not just speaking about this but executing on it.
As a company, our mission is to be an indispensable source of business knowledge, innovation and support to the practices in our network. We are advocates for our Ob-Gyn medical affiliates – enabling them to focus solely on the practice of medicine while we focus on the business of medicine.
We are action oriented. We strategize, implement and execute – on behalf of the practices we serve.
The Revenue Cycle Claim Specialist ensures accurate billing and collection of medical services by performing essential financial processes, adhering to regulations and compliance guidelines, while maintaining the highest standards of patient confidentiality and data security. This includes editing and resolving claims according to regulations and compliance guidelines, patient account research and resolution, insurance verification and benefit determinations, identification of reimbursement issues, resolution of credits and issuance of refunds, identification of payment variance on invoices, and follow-up and resolution of denied claims. This role is responsible for the timely and accurate working of correspondence, denials, and insurance follow-up.
- Monitor and execute work on assigned worklists, reports, projects, or team goals.
- Research and resolve claims based on assignment, which could include: contacting payers via phone or website, contacting practices, working across departments, writing appeals and facilitating their submission, and all other activities that lead to the successful adjudication of eligible claims.
- Design and generate reports for analysis, trending, and subdivision of work to communicate with internal stakeholders.
- Manage and resolve posting issues, manage remittance and all correspondence in each of the EMR dashboards daily.
- Illustrate excellent knowledge of healthcare industry regarding the Revenue Cycle and state insurance laws
- Meet productivity standards as set by management
- Escalate identification of chronic issues with service locations to immediate supervisor
- Demonstrate knowledge and understanding of insurance billing procedures as evidenced by the identification of root-causes of claim issues and proposed resolutions to ensure timely and appropriate payment
- Educate and communicate Revenue Cycle/financial information to patients, payers, co-workers, managers and others as necessary to ensure accurate processes.
- Determine accuracy of Insurance payments and Initiate, Follow Up, and Respond on payer reimbursement issues
- Communicate with Practices and Payers regarding claim denials and payer trends
- High school diploma or equivalent, Associates degree from an accredited university preferred
- Minimum of 3 years’ experience as a biller, collector, coder, or back-office support staff
- Experience in an OB/GYN setting preferred
- Ability to collaborate effectively in a cross-functional team environment
- Experience working with healthcare practice management systems, (Athenanet preferred)
- Knowledge of payer processes, local, state, and federal requirements
- Excellent written and oral communication skills
- Experience working with cloud-based Customer Relationship Management (CRM) technology (Salesforce preferred)
- Outstanding customer service skills
- Advanced knowledge of Microsoft Office
- Strong organizational, problem solving and decision-making skills
- Ability to prioritize and manage multiple projects and issues effectively and simultaneously
- Self-motivated and self-starter who can work well under minimal supervision
- Strong attention to detail, research and follow up skills
- Ability to work both independently and in a team setting
- Experience and knowledge of commercial and governmental insurance payer and clearinghouse portals (Availity, Navinet, Optum, etc.) including billing guidelines and policy updates
- Working knowledge of Medical Billing & Coding required, Certification preferred
